Quality Of Anastomosis Research Articles

Basic Surgical Skill Training before a Vascular Course Improves the Quality of Vascular Anastomoses: A Randomized Controlled Trial

ObjectivesDuring the past decade simulation has become standard in most surgical training programs, but objective evaluation of the performance has been a challenge. The optimal components of open surgery's simulation have also been questioned. The goal of this study was to evaluate the benefit of adding a hands-on exercise prior to a formal vascular training course. The participants’ performance was objectively evaluated using Computional Fluid Dynamics (CFD) assessment of vascular anastomoses. MethodsIn this study 51 residents participated in an on-line surgical hands-on training course, performing six end-to-side anastomoses. The residents were randomly divided into two groups. Group 1. also underwent basic surgical skill training (BSST) before starting the vascular course. The groups were compared based on CFD assessment of vascular anastomoses, combined with on-line personalized feedback. ResultsAmong measured parameters of functional assessment, the mean of six anastomoses showed significantly better results in Group 1. when compared with control Group 2 (Oscillatory Shear Index: 0,022 vs. 0,025 p=0,002; Maximum pressure: 7939 vs. 7971 p=0,00037; Velocity: 0,12 vs. 0,12 p=0,0000; Helicity: 297 vs. 393 p=0,0065; Vorticity: 5258 vs. 6628 p=0,0019; Wall Shear Stress: 1,83 vs. 1,97 p= 0,000047). These results showed no significant correlation between participants' experience level, specialization, and workplace. ConclusionsBSST before a formal vascular simulation course positively affects the anastomosis quality, independent of experience level, specialization, and workplace. BSST is suggested before a vascular course to improve performance and progress. Further studies are needed to analyse the impact of this combined simulation training on performing anastomoses.

Robotic-assisted microsurgery using the MUSA-robot: evaluation of the learning curve in three clinical pilot trials

Aim: Current microsurgical procedures are limited by the physiological tremor and dexterity of the surgeon. The MicroSurgical Assistant (MUSA, Microsure), the world’s first robotic platform for (super)microsurgery can aid in resolving issues encountered during microsurgery. This study presents an overview of the operating times and Structured Assessment of Microsurgery Skills (SAMS) scores to assess the duration and quality of microsurgical anastomoses for three microsurgical procedures currently performed using the MUSA. Methods: This study integrates data from one ongoing randomized controlled trial focusing on robotic-assisted lymphaticovenous anastomosis, along with findings from two separate prospective pilot studies concerning digital nerve repair and free tissue transplantation. SAMS scores and time needed per anastomosis were used to evaluate the quality and learning curve of the MUSA-assisted procedures. Results: Thirty-five robotic-assisted procedures were analyzed, including 18 lymphaticovenous anastomoses, 9 digital nerve repairs, and 8 free tissue transplantations. All procedures showed a trend of a decrease in the time needed to perform the procedure. Moreover, the mean overall SAMS scores for all three procedures were rated above ‘satisfactory’, with all procedures demonstrating a consistent trend of increasing SAMS scores over time. Conclusion: The evaluation of anastomosis’ quality in the initial cohorts of patients undergoing robotic-assisted microsurgery using MUSA indicates satisfying outcomes across all three types of procedures. The reduction in anastomosis time and the improvement in SAMS scores imply an ongoing learning process among the operating surgeons. Subsequent reports are expected to provide information on reaching a plateau phase in procedural efficiency.

Could trainees' finger placement at the surgeon's console affect overall outcomes of robotic surgery in radical prostatectomy? A prospective, blinded, robotic simulation pilot study.

Robotic surgery for localized prostate cancer offers a greater range of motion attributed to the EndoWrist instruments. Postoperative outcomes are linked to the quality of vesico-urethral anastomosis. Trainees frequently complain of suturing difficulty in a back-handed fashion. We aimed to analyze wrist motion using the DaVinci simulator. We hypothesized that using the thumb and index finger would allow superior surgical proficiency when compared to the middle finger. After institutional review board approval, we recruited 42 medical students in one academic medical center. Students were randomly assigned to start with their thumb and index finger (1&2) or thumb and middle finger (1&3). Three standardized modules were used with nine metrics calculated, including: score, total time, economy of motion, efficiency score, collisions, inaccurate puncture, wound approximation, out of view, and penalty subtotal. Statistical analysis of the metrics was calculated using SPSS. Three metrics were found to have differences between the finger placement of 1&3 compared to 1&2. The number of collisions, wound approximation, and penalty score where 1&3 were used had a lower score in each. The number of collisions was 5.7 less in the 1&3 finger placement (p=0.046). This metric was found to have statistically significant differences between finger placement where 1&3 had a lower score compared to 1&2. The wound approximation score was 0.2 points lower when using the 1&3 placement (p=0.075). Lastly, the penalty assigned was 6.5 points lower when using 1&3 (p=0.069). Although finger placement did not affect the overall score of the completed simulation, instrument collisions and unnecessary wound complications may lead to adverse outcomes when using 1&2 despite offering a wider range of motion. This may be due to decreased comfort in hand position. Trainees may be able to improve the effectiveness of their vesico-urethral anastomosis during robotic-assisted radical prostatectomy.

Effect of Laterality in Microsurgery: Comparative Study of an Expert and a Novice.

Background: Hand laterality has an impact on surgical gestures. In this study, we sought to measure the multi-parameter variability of the microsurgical gesture depending on the hand used and the differences between expert microsurgeons and novices. Methods: Ten experienced microsurgeons and twenty medical students with no prior microsurgical experience performed arterial anastomosis on a chicken wing artery using dominant and non-dominant hands. We measured time and force using a homemade force-sensing microsurgical needle holder, heart rate variability with a Polar H10 chest strap, anxiety with the STAI-Y questionnaire and anastomosis quality using the MARS 10 scale. Results: In the microsurgeons' group, duration of anastomosis (p = 0.037), force applied to the needle holder (p = 0.047), anxiety (p = 0.05) and MARS10 (p = 0.291) were better with the dominant hand. For novices, there was no difference between the dominant and non-dominant hand pertaining to force, time and stress level. There were no differences between microsurgeons and novices pertaining to force and anxiety using the non-dominant hand. Conclusions: The study highlighted a marked laterality among microsurgical experts, a finding that may be explained by current learning methods. Surprisingly, no laterality is observed in students, suggesting that for a specific gesture completely different from everyday tasks, laterality is not predefined. Ambidexterity training in the residency curriculum seems relevant and may help microsurgeons improve performance and postoperative outcomes.

Ideal suturing technique for robot-assisted microsurgical anastomoses

The development of novel robotic devices specifically designed for open microsurgery leads to increasing applications in reconstructive procedures. While initial studies revealed improved precision and surgical ergonomics upon robotic assistance, surgical time was consistently observed to be increased. This study compares two robotic suturing techniques using the Symani Surgical System and RoboticScope in a preclinical setting, to further leverage the benefits of novel robotic devices in microsurgery. Six experienced microsurgeons performed three microvascular anastomoses with a “steady-thread” suturing technique and a “switch-thread” technique on 1.0-mm-diameter artificial silicone vessels. Time for anastomosis and participant’s satisfaction with the techniques and robotic setup were recorded. Anastomosis quality and microsurgical skills were assessed using the Anastomosis Lapse Index and Structured Assessment of Microsurgery Skills. Lastly, technical error messages and thread ruptures were quantified. Knot tying was significantly faster and evaluated significantly better by participants using the steady-thread technique (4.11 ± 0.85 vs. 6.40 ± 1.83 min per anastomosis). Moreover, microsurgical skills were rated significantly better using this technique, while both techniques consistently led to high levels of anastomosis quality (2.61 ± 1.21 vs. 3.0 ± 1.29 errors per anastomosis). In contrast, the switch-thread technique was associated with more technical error messages in total (14 vs. 12) and twice as many unintended thread ruptures per anastomosis (1.0 ± 0.88 vs. 0.5 ± 0.69). This study provides evidence for the enhanced performance of a steady-thread suturing technique, which is suggested to be applied upon robot-assisted microsurgical procedures for optimized efficiency.

Preclinical Performance of the Combined Application of Two Robotic Systems in Microsurgery: A Two-center Study.

Recent advancements in the development of robotic devices increasingly draw the attention toward the concept of robotic microsurgery, as several systems tailored to open microsurgery are being introduced. This study describes the combined application of a novel microsurgical robot, the Symani, with a novel robotic microscope, the RoboticScope, for the performance of microvascular anastomoses in a two-center preclinical trial. Six novices, residents, and experienced microsurgeons (n = 18) performed five anastomoses on 1.0-mm-diameter silicone vessels with a conventional versus combined robotic approach, resulting in 180 anastomoses. Microsurgical performance was evaluated, analyzing surgical time, subjective satisfaction with the anastomosis and robotic setup, anastomosis quality using the anastomosis lapse index score, microsurgical skills using the Structured Assessment of Microsurgery Skills score, and surgical ergonomics using the Rapid Entire Body Assessment score. All participants significantly improved their performance during the trial and quickly adapted to the novel systems. Surgical time significantly decreased, whereas satisfaction with the anastomosis and setup improved over time. The use of robotic systems was associated with fewer microsurgical errors and enhanced anastomosis quality. Especially novices demonstrated accelerated skill acquisition upon robotic assistance compared with conventional microsurgery. Moreover, upper extremity positioning was significantly improved. Overall, the robotic approach was subjectively preferred by participants. The concept of robotic microsurgery holds great potential to improve precision and ergonomics in microsurgery. This two-center trial provides promising evidence for a steep learning curve upon introduction of robotic microsurgery systems, suggesting further pursuit of their clinical integration.

Even short-term training improves the skills of novice exoscope users: a prospective laboratory experiment

BackgroundThe surgical 3D exoscopes have recently been introduced as an alternative to the surgical microscopes in microneurosurgery. Since the exoscope availability is still limited, it is relevant to know whether even a short-term exoscope training develops the skills needed for performing exoscope-assisted surgeries.MethodsTen participants (six consultants, four residents) performed two laboratory bypass test tasks with a 3D exoscope (Aesculap Aeos®). Six training sessions (6 h) were performed in between (interval of 2–5 weeks) on artificial models. The participants were divided into two groups: test group (n = 6) trained with the exoscope and control group (n = 4) with a surgical microscope. The test task was an artificial end-to-side microsurgical anastomosis model, using 12 interrupted 9–0 sutures and recorded on video. We compared the individual as well as group performance among the test subjects based on suturing time, anastomosis quality, and manual dexterity.ResultsAltogether, 20 bypass tasks were performed (baseline n = 10, follow-up n = 10). The median duration decreased by 28 min and 44% in the exoscope training group. The decrease was steeper (29 min, 45%) among the participants with less than 6 years of microneurosurgery experience compared to the more experienced participants (13 min, 24%). After training, the participants with at least 1-year experience of using the exoscope did not improve their task duration. The training with the exoscope led to a greater time reduction than the training with the microscope (44% vs 17%).ConclusionsEven short-term training with the exoscope led to marked improvements in exoscope-assisted bypass suturing among novice microneurosurgeons. For the more experienced participants, a plateau in the initial learning curve was reached quickly. A much longer-term effort might be needed to witness further improvement in this user group.

European Society of Pediatric Radiology survey of perioperative imaging in pediatric liver transplantation: (2) intraoperative imaging

BackgroundLiver transplantation is the state-of-the-art curative treatment for end-stage liver disease. Imaging is a key element in the detection of intraoperative and postoperative complications. So far, only limited data regarding the best radiological approach to monitor children during liver transplantation is available.ObjectiveTo harmonize the imaging of pediatric liver transplantation, the European Society of Pediatric Radiology Abdominal Taskforce initiated a survey addressing the current status of imaging including the pre-, intra- and postoperative phase. This paper reports the responses related to intraoperative imaging.Materials and methodsAn online survey, initiated in 2021, asked European centers performing pediatric liver transplantation 48 questions about their imaging approach. In total, 26 centers were contacted, and 22 institutions from 11 countries returned the survey.ResultsIntraoperative ultrasound (US) is used by all sites to assess the quality of the vascular anastomosis in order to ensure optimal perfusion of the liver transplant. Vessel depiction is commonly achieved using color Doppler (95.3%). Additional US-based techniques are employed by fewer centers (power angio mode, 28.6%; B-flow, 19%; contrast-enhanced US, 14.3%). Most centers prefer a collaborative approach, with surgeons responsible for probe handling, while radiologists operate the US machine (47.6%). Less commonly, the intraoperative US is performed by the surgeon alone (28.6%) or by the radiologist alone (23.8%). Timing of US, imaging frequency, and documentation practices vary among centers.ConclusionIntraoperative US is consistently utilized across all sites during pediatric liver transplantation. However, considerable variations were observed in terms of the US setup, technique preferences, timing of controls, and documentation practices. These differences provide valuable insights for future optimization and harmonization studies.

Surgical management for the intra-abdominal infection secondary to perforation of digestive tract

Abdominal infection caused by digestive tract perforation is a common cause of emergency surgery. In most cases, resection of the diseased intestinal segment is required. After resection, whether to perform a one-stage anastomosis or a stomy is the key to perplexing clinicians. With the continuous improvement of surgical technology and the increasing demand of patients to improve their quality of life, one-stage resection and anastomosis have become the most ideal surgical method. However, due to the concern about postoperative anastomotic leakage, the clinical practice of postoperative stoma rate is still high. This article reviews the surgical treatment of abdominal infection caused by gastrointestinal perforation in recent years, and discusses various preventive measures for anastomotic leakage after primary anastomosis, so as to improve the rate of primary anastomosis, which is of great significance for improving the quality of life of patients and reducing the medical burden.

Unformed conglomerate debilitating jejunal fistulas and their two-stage surgical treatment via posterolateral laparotomy

To create a method of two-stage repair of high unformed conglomerate delimited debilitating jejunal fistulas via posterolateral laparotomy with low risk of surgical complications. Methodology and treatment outcomes were analyzed in 37 patients with unformed conglomerate high debilitating delimited jejunal fistulas. Of these, 22 patients underwent one-stage treatment through 2 converging incisions and/or two-stage treatment through anterolateral access. They made up a control group. Fifteen patients in the main group underwent two-stage treatment via posterolateral left-sided laparotomy with unilateral disconnection of jejunum with fistula. In most patients of both groups, fistulas complicated surgery for acute adhesive intestinal obstruction. Topography of adhesions that caused acute intestinal obstruction in both groups was studied in 172 other patients. Identical jejunal fistulas and two different surgical approaches made it possible to consider our groups representative. Two-stage treatment via posterolateral left-sided laparotomy reduced mortality from 63.6±10.2% to 20.0±10.3% (t=11.8; p<0.001). This approach simplified intraoperative diagnostics that became more informative. Posterolateral access increased the quality of anastomosis and safety of viscerolysis. A new two-stage approach with posterolateral left-sided laparotomy allowed atraumatic imposing of inter-intestinal anastomosis with proximal disconnection of jejunal fistula. This exclusion turns the fistula into analogue of the definitive Meidl's jejunostomy, unloads the intestinal anastomosis and increases the quality of suture. New strategy reduced the risk of complications and mortality.

Application of intraoperative endoscopic in laparoscopic gastric cancer surgery

The application of intraoperative endoscopic in laparoscopic gastric cancer surgery can compensate for the limitations of a single laparoscopic mode that only relies only on serous vision, and work as the Chinese saying "four ounces can move a thousand pounds". Intraoperative endoscopy not only effectively helps to accurately locate the tumor boundary in real-time and achieve precise resection, but also enables real time and interactive inspection of the quality of esophagojejunal anastomosis, reduces postoperative complications such as anastomotic leakage and bleeding, and accelerates postoperative recovery. However, most centers in China do not emphasize the application of intraoperative endoscopy in laparoscopic gastric cancer surgery due to the lack of a good cooperation mechanism between the gastrointestinal surgery team and the digestive endoscopy team. Therefore, based on clinical practice experience, the author briefly discusses the application of intraoperative endoscopic in routine laparoscopic gastric cancer surgery, including pre-examination preparation operator position, endoscopic techniques, postoperative management, etc., covering application scenarios such as early tumor localization, confirmation of upper esophageal margin confirmation, anastomotic examination, biopsy of primary lesion specimens in neoadjuvant/conversion treatment cases. We hope that it will help gastroenterologists to better apply intraoperative endoscopy in laparoscopic gastric cancer surgery, and assist in precise resection and safe anastomosis of the operation.

Effect of Sleep Deprivation on Simulated Microsurgical Vascular Anastomosis.

The effects of sleep deprivation on surgical performance have been well documented. However, reports on the effects of sleep deprivation on microneurosurgery are limited. This study aimed to investigate the effects of sleep deprivation on microneurosurgery. Ten neurosurgeons participated in the anastomosis of a vessel model using a microscope in sleep-deprived and normal states. We evaluated the procedure time (PT), stitch time (ST), interval time (IT), number of unachieved movements (NUM), leak rate, and practical scale for anastomosis quality assessment. Each parameter was compared between normal and sleep-deprived states. Subanalyses were performed on the two groups based on PT and NUM under the normal state (proficient and nonproficient groups). Although no significant differences were noted in PT, ST, NUM, leak rate, or practical scale, IT was significantly prolonged under sleep deprivation compared with the normal state (mean: 258.8 ± 94.0 vs. 199.3 ± 74.9 seconds; p = 0.02). IT was significantly prolonged under sleep deprivation in the nonproficient group based on both PT and NUM (PT: 234.2 ± 71.6 vs. 321.2 ± 44.7 seconds, p = 0.04; NUM: 173.3 ± 73.6 vs. 218.7 ± 97.7; p = 0.02), whereas no significant difference was observed in the proficient group (PT: 147.0 ± 47.0 vs. 165.3 ± 61.1 seconds, p = 0.25; NUM: 173.3 ± 73.6 vs. 218.7 ± 97.7; p = 0.25). Although IT was significantly prolonged under sleep deprivation in the nonproficient group, there was no decline in performance skills in either the proficient or nonproficient group. The effect of sleep deprivation may require caution in the nonproficient group, but it is possible that certain microneurosurgical outcomes can be achieved under sleep deprivation.

Piglet Model for Modified Blalock-Taussig-Thomas Shunt Training

BackgroundThe Blalock-Taussig-Thomas shunt is one of the milestone procedures in cardiac surgery and a crucial operation for palliating blue babies. It is currently impractical to train new surgeons on infants even under the supervision of their mentors. A realistic training model for location, exposure, tissue toughness, and texture is required. The objective of this study was to determine whether the model is realistic and practical and to evaluate the quality of anastomosis performed by surgical trainees. MethodsPiglet heart and lung models were selected from piglets of 3 to 5 kg. Six cardiothoracic surgical residents participated in the program and performed the procedure. Subsequently, every trainee answered a standard questionnaire in terms of satisfaction in reality and practicality; the trainers evaluated the quality of the anastomosis. The median score of each item was analyzed and described. The quality of anastomosis was evaluated and analyzed similarly. ResultsMedian scores of satisfaction (14 questions) were 9, 10, 9, 9.5, 10, 9.5, 10, 9.5, 10, 8.5, 10, 8.5, 10, and 8. Median challenge scores (6 questions) were 10, 10, 10, 10, 10, 9.5, and 10. The median anastomosis evaluation score from 6 trainees was 25 (24-25). ConclusionsOur heart-lung simulation model is perhaps 1 of the most realistic simulations in practicality, visualization, exposure of the related structures, similar scenes to the real operation, and sense of touch and texture. Realistic models should be developed, but they should be inexpensive.

Development of a Sensor Technology to Objectively Measure Dexterity for Cardiac Surgical Proficiency

BackgroundTechnical skill is essential for good outcomes in cardiac surgery. However, no objective methods exist to measure dexterity while performing surgery. The purpose of this study was to validate sensor-based hand motion analysis (HMA) of technical dexterity while performing a graft anastomosis within a validated simulator. MethodsSurgeons at various training levels performed an anastomosis while wearing flexible sensors (BioStamp nPoint, MC10 Inc) with integrated accelerometers and gyroscopes on each hand to quantify HMA kinematics. Groups were stratified as experts (n = 8) or novices (n = 18). The quality of the completed anastomosis was scored using the 10 Point Microsurgical Anastomosis Rating Scale (MARS10). HMA parameters were compared between groups and correlated with quality. Logistic regression was used to develop a predictive model from HMA parameters to distinguish experts from novices. ResultsExperts were faster (11 ± 6 minutes vs 21 ± 9 minutes; P = .012) and used fewer movements in both dominant (340 ± 166 moves vs 699 ± 284 moves; P = .003) and nondominant (359 ± 188 moves vs 567 ± 201 moves; P = .02) hands compared with novices. Experts’ anastomoses were of higher quality compared with novices (9.0 ± 1.2 MARS10 vs 4.9 ± 3.2 MARS10; P = .002). Higher anastomosis quality correlated with 9 of 10 HMA parameters, including fewer and shorter movements of both hands (dominant, r = −0.65, r = −0.46; nondominant, r = −0.58, r = −0.39, respectively). ConclusionsSensor-based HMA can distinguish technical dexterity differences between experts and novices, and correlates with quality. Objective quantification of hand dexterity may be a valuable adjunct to training and education in cardiac surgery training programs.

Metagenomics of microbiota following probiotic supplementation in rats subjected to intestinal anastomosis

BackgroundThe use of probiotics positively modifies the composition and function of the intestinal flora, decreasing inflammation, and these changes improve the quality of intestinal anastomosis. Therefore, the objective of this study was to evaluate the metagenomics of the microbial community after probiotic supplementation in rats subjected to intestinal anastomosis. MethodsThe probiotic chosen for this study was composed of the strains Lactobacillus paracasei LPC37, Bifidobacterium lactis HN0019, Lactobacillus rhamnosus HN001 and Lactobacillus acidophilus NCFM. Both groups underwent two colostomies, one in the right colon and the second in the rectosigmoid colon, followed by anastomosis with eight interrupted stitches. The rats were killed on the fifth day of PO. Changes in the intestinal microbiota were evaluated by means of a metagenomic study that evaluated bacterial alpha and beta diversity indices. ResultsAlthough there were no significant differences for any alpha diversity index, changes were observed for beta diversity indexes in the microbiota of rats. The group that received the probiotic preserved and even increased the abundance of beneficial bacterial genera and, at the same time, decreased the abundance of potentially pathogenic bacteria, promoting a favorable environment for anastomoses' healing. ConclusionThe use of probiotics had a positive impact on the quality of the intestinal microbiota.

Evaluation of anastomosis quality with intraoperative transit time flowmeter in minimally invasive multi-vessel coronary artery bypass grafting via left anterior mini-thoracotomy.

In this study, we aimed to describe our intraoperative transit-time flow measurement results as an integral component of the operation and evaluate the graft patency and anastomosis quality in patients who underwent minimally invasive multi-vessel coronary artery bypass grafting via mini-thoracotomy. Between May 2020 and September 2021, a total of 45 consecutive patients (32 males, 13 females; mean age: 51.2±8.6 years; range, 41 to 72 years) who underwent minimally invasive multi-vessel coronary artery bypass grafting via left anterior mini-thoracotomy were retrospectively analyzed. We used the technique of intraoperative transit-time flowmetry in all patients. The patients were operated under cardiopulmonary bypass. A saphenous vein graft was used in all anastomoses, except for the left internal thoracic artery. The mean left internal mammary artery flow rate was 36.2±14.1 mL/min, mean flow rate of the diagonal grafts was 48.2±13.1 mL/min, mean flow rate of the circumflex grafts was 41.2±21.1 mL/min, and mean flow rate of the right coronary artery grafts was 52.2±11.3 mL/min. Wave patterns and flow parameters of all grafts were normal in the intraoperative measurements, since the pulsatility index values in all anastomoses were within normal limits. The operation was completed after anastomotic openings and graft patency were ensured. The use of an intraoperative flowmeter to show the graft patency and anastomosis quality gives confidence both to the surgeon and the patient. In multi-vessel coronary artery bypass grafting via mini-thoracotomy, anastomosis quality can be evaluated well with this technique.

New computational fluid dynamics-based method for morphological and functional assessment in cardiovascular skill training.

During cardiovascular surgical skill training, the direct quantification regarding surgical performance is still lacking, including transferring clinically relevant information. We introduced a novel computational fluid dynamics-based method in support of vascular surgical hands-on training, which applies continuous self-assessment in vascular anastomoses. The validation of the methodology was implemented in comparing with conventional training courses. The fifth and seventh consecutive anastomoses of the experimental group showed significantly improved results regarding anastomosis quality when compared with the control group. Consecutive demonstration of three-dimensional morphology and functional assessment of anastomoses results in improved practical performance among learners regarding anastomosis quality.

Design and Evaluation of Self-Cooling Electrodes for Radiofrequency Intestinal Anastomosis

Abstract Colorectal cancer is a common malignant tumor in the gastrointestinal tract. Resection of the cancerous site and anastomosis of the residual intestine is the preferred radical treatment for colorectal cancer. In particular, radio frequency energy anastomosis of the residual intestine is being increasingly used in clinical practice. To improve the quality of anastomosis, reduce the thermal damage of tissue near the anastomosis area, and avoid foreign body residue in this area, we propose a self-cooling eversion-type radio frequency-energy intestinal anastomosis electrode, which is analyzed through simulations and evaluated experimentally for welding intestinal tissue. For radio frequency energy power of 160 W, anastomosis time of 13.2 s, and pressure of 154 kPa, the disconnected intestinal tissues can be anastomosed using the proposed electrode. The average burst pressure of the anastomotic orifice is 43.86 mmHg. During welding, the temperature of the normal saline at the outlet is 6.8 °C higher than that at the inlet, indicating that the use of circulating normal saline as the conductive and cooling medium can dissipate part of the heat generated by welding and reduce heat accumulation, thereby reducing thermal damage of biological tissue near the welding area. Overall, the proposed electrode may contribute to the recovery of postoperative intestinal function by enabling a novel strategy for clinical intestinal anastomosis induced by radio frequency energy.

Conventional versus fibrin-glue-augmented arterial microanastomosis: An experimental study

The purpose of this experimental study was to develop an alternative technique of arterial microanastomosis using only 2 stay-sutures augmented with fibrin glue, and to compare it to the conventional technique in arteries of varying diameters mimicking hand arteries. Eight anastomoses were performed in 7 male rats, including 1 anastomosis each on the 2 femoral, iliac, and carotid arteries, and 2 on the subrenal aorta. The conventional technique was used on one side and on the first aorta anastomosis, while augmented anastomoses were performed on the other side and on the second aorta. Patency was tested 10 min after unclamping; clamping time, blood loss, anastomosis quality score (out of 15 points) and artery diameter were recorded. In arteries of diameter 0.5−2.2 mm, augmented anastomoses were on average 10.7 ± 3.2 min faster to perform (p < 0.0001), with an average of 1.3 ± 0.9 g less blood loss (p < 0.0001) and an average of 2.6 ± 2.5 points higher quality score (p < 0.0001). There were no significant differences between the two techniques in terms of patency rate, regardless of artery size. However, 3 of the 7 augmented anastomoses were non-permeable in the femoral subgroup (i.e., submillimetric arteries). This straightforward technique appears to be time-saving and reliable, provided that the repaired artery is of sufficient size. Subject to clinical validation, this technique might help surgeons treating extensive hand wounds with multiple severed neurovascular bundles.

Vessel anastomosis in free flap reconstruction for oral and maxillofacial defects: techniques and key points.

The quality of vessel anastomosis is a key element for the success of free flap reconstruction. When adopting free flaps for oral and maxillofacial defect reconstruction, skills in selecting vessels, determining the clinical manifestations of the recipient vessel, and anastomosis technique are needed. Key points on postoperative flap observation were also required. We are experienced on this subject given that we have accomplished more than 1 000 free flaps for patients with oral and maxillofacial defects in the last 5 years. In this article, we summarize the skills and key points in free flap reconstruction of oral and maxillofacial defects, including vessel anastomosis skills, vessel selection, and vessel crisis diagnosis.